Choosing Appropriate Techniques

Choosing Appropriate Techniques

When today's psychiatrist does psychotherapy, it is most likely supportive psychotherapy. Because it is well-tolerated by patients and its results are at least equal to those of other psychotherapies, David Hellerstein and colleagues (1994) called supportive psychotherapy the default model and believed it should be the therapy of first choice.

Robert Knight, M.D., one of the first psychiatrists to discuss supportive psychotherapy, wrote (Knight, 1949):

Suppressive or supportive psychotherapy, also called superficial psychotherapy, utilizes such devices as inspiration, reassurance, suggestion, persuasion, counseling, reeducation, and the like and avoids investigative and exploratory measures.

He later added a list of techniques to use for supportive psychotherapy (Knight, 1952):

Instruction of the patient in areas of knowledge and adaptation where he is deficient encouragement, advice, active help in feasible management of the environment; appropriate coaxing, exhortation, kidding and praise; prescription of daily activities, including mental hygiene reading; provisions of support through a nurse or companion; long range support through less frequent continuing supportive interviews as the patient improves.

He also included hospitalization as an option.

Knight had a psychoanalytic perspective. For healthier patients, expressive, exploratory or psychoanalytic therapy was preferred. For the more psychologically impaired patient, supportive therapy was the treatment of choice. The purpose of supportive therapy was to "reconstruct the defense mechanisms and adaptive methods [of the patient] before his decompensation" (Knight, 1952).

The model for supportive psychotherapy Knight proposed is similar to the one we use today. Knight's devices, now called techniques, however, have steadily increased in number as each subsequent author has added new ones.

One of Misch's (2000) suggested techniques, for instance, is to capitalize on the therapist as a role model: Let the patient see how the therapist handles anger, confusion, embarrassment, disappointment and failure. He noted:

The supportive therapist is a good selfobject, providing needed mirroring, idealizing, and twinship experiences that allow the patient to internalize important psychological functions that are currently deficient.